1
|
Karampas G, Witkowski M, Metallinou D, Steinwall M, Matsas A, Panoskaltsis T, Christopoulos P. Delivery Progress, Labor Interventions and Perinatal Outcome in Spontaneous Vaginal Delivery of Singleton Pregnancies between Nulliparous and Primiparous Women with One Previous Elective Cesarean Section: A Retrospective Comparative Study. Life (Basel) 2023; 13:2016. [PMID: 37895398 PMCID: PMC10608638 DOI: 10.3390/life13102016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/25/2023] [Accepted: 09/26/2023] [Indexed: 10/29/2023] Open
Abstract
Trial of labor after cesarean (TOLAC) is an alternative to repeated cesarean for women with singleton pregnancy and one previous transverse lower segment cesarean section (LSCS), resulting in most cases being a successful vaginal birth after cesarean section (VBAC). The primary objective of this study was to examine if the progress and the duration of the active first stage and the second stage of labor in nulliparous women with singleton pregnancy, spontaneous start of labor and vaginal birth differ from primiparous women succeeding VBAC after one previous elective LSCS in a country with a low cesarean section and high VBAC rate. Secondary objectives were to compare labor interventions and maternal-neonatal outcomes between the two groups. METHODS This is a retrospective comparative study. Data were collected in a four-year period at the departments of Obstetrics and Gynecology at Kristianstad and Ystad hospitals in Sweden. Out of 14,925 deliveries, 106 primipara women with one previous elective LSCS and a spontaneous labor onset in the subsequent singleton pregnancy were identified. Of these women, 94 (88.7%) delivered vaginally and were included in the study (VBAC group). The comparison group included 212 randomly selected nulliparous women that had a normal singleton pregnancy, spontaneous labor onset and delivered vaginally. RESULTS The rate of cervical dilation during the active first stage of labor as well as the duration of the second stage did not differ between the two groups. When adjusting for cervical dilation at admission, there was no significant difference between the two groups regarding the duration of the active phase of the first stage of labor. No significant differences were found in maternal-neonatal outcomes between the two groups except for higher birth weight in the VBAC group. The use of epidural analgesia was associated with slower dilation rhythm over the duration of the active phase and second stage of labor, need for labor augmentation, postpartum bleeding and need for transfusion at higher rates, irrespective of parity when epidural was used. CONCLUSIONS Our study provides evidence that in women with one previous elective LSCS undergoing TOLAC in the subsequent pregnancy resulting in vaginal birth, the progress and duration of labor are not different from those in nulliparous women when labor is spontaneous and the it is a singleton pregnancy. The use of epidural was associated with prolonged labor, need for labor augmentation and higher postpartum bleeding, irrespective of parity. This information may be useful in patient counseling and labor management in TOLAC.
Collapse
Affiliation(s)
- Grigorios Karampas
- Department of Obstetrics and Gynecology, Skånes University Hospital, 21428 Malmö-Lund, Sweden
- Second Department of Obstetrics & Gynecology, Medical School, University of Athens “Aretaieion” Hospital, 11528 Athens, Greece
| | - Martin Witkowski
- Department of Obstetrics and Gynecology, Kristianstad/Ystad Community Hospitals, 27133 Ystad, Sweden
| | - Dimitra Metallinou
- Department of Midwifery, University of West Attica, 12243 Athens, Greece
| | - Margareta Steinwall
- Department of Obstetrics and Gynecology, Kristianstad/Ystad Community Hospitals, 27133 Ystad, Sweden
| | - Alkis Matsas
- Second Department of Obstetrics & Gynecology, Medical School, University of Athens “Aretaieion” Hospital, 11528 Athens, Greece
| | - Theodoros Panoskaltsis
- Second Department of Obstetrics & Gynecology, Medical School, University of Athens “Aretaieion” Hospital, 11528 Athens, Greece
| | - Panagiotis Christopoulos
- Second Department of Obstetrics & Gynecology, Medical School, University of Athens “Aretaieion” Hospital, 11528 Athens, Greece
| |
Collapse
|
2
|
Lan Y, Pan S, Chen B, Peng L, Chen R, Hua Y, Ma Y. Labor characteristics and intrapartum interventions in women with vaginal birth after cesarean section. BMC Pregnancy Childbirth 2022; 22:589. [PMID: 35870907 PMCID: PMC9308341 DOI: 10.1186/s12884-022-04919-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 07/15/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
With the development of China’s two-child-policy, vaginal birth after cesarean section (VBAC) has aroused public concern. It is important to understand the labour characteristics and intrapartum management of women attempting VBAC to enhance the rates of successful VBAC. The purpose of our research was to investigate the differences in the characteristics of labor, intervention measures and perinatal outcomes between women who had a VBAC and primiparas or multiparas not undergoing VBAC, providing clinical references of intrapartum management for women who are planning a VBAC.
Material and methods
This observational retrospective study enrolled all women who laboured spontaneously and who had a VBAC (n = 139) at the Second Affiliated Hospital of Wenzhou Medical University in China between 2016 and 2019. They were allocated into VBAC group A (the previous cesarean section was performed before dilation of the cervix) and VBAC group B (the previous cesarean section was performed after dilation of the cervix). The primipara control group included 149 primiparae, and the multipara control group included 155 multiparae with second vaginal birth. Durations of labor, intervention measures and perinatal outcomes were compared among the groups.
Results
The durations of labor, intrapartum interventions and maternal and neonatal outcomes in VBAC group A were similar to those of the VBAC group B. However, all women who had a VBAC and those in VBAC group A had shorter first, second and the total stages of labor than primiparae. All women with VBAC and those in VBAC group B had longer second stage of labor, but shorter third stage of labor than multiparae. Oxytocin, labor analgesia and artificial rupture of membranes were administered less often in women with VBAC than in primiparae, while phloroglucinol was administered more often in women with VBAC than in multiparae. Women who had a VBAC were more likely to receive episiotomy and had higher incidences of postpartum hemorrhage than primipara and multipara women.
Conclusions
Labor characteristics, intrapartum interventions and perinatal outcomes in women who had a VBAC with cervical dilation were similar to those in women who had a VBAC without cervical dilation before the previous cesarean section, but differed significantly from those of multiparae and primiparae who did not undergo VBAC.
Collapse
|
3
|
Bayoumi YA, Alalfy M, Sharkawy M, Ali AS, Gouda HM, Hatem DL. Castor oil for labor initiation in women with a previous cesarean section: a double-blind randomized study. J Matern Fetal Neonatal Med 2021; 35:8945-8951. [PMID: 34886746 DOI: 10.1080/14767058.2021.2008350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Objective: To evaluate the efficacy of castor oil in initiation of labor in women who had one previous cesarean section. This study was conducted as a trial to increase the rate of vaginal birth after cesarean (VBAC) and decrease the rate of elective repeated cesarean section (ERCS).Methods: A double-blinded randomized controlled study was conducted in an Egyptian University Hospital from July 2019 to July 2020. The participants were 70 pregnant women who had one previous cesarean section, singleton pregnancy in cephalic presentation, with a Bishop score ≤6 attempting to perform a trial of labor. Sixty mL castor oil was administered to group A and 60 mL sunflower oil was administered to group B (as a placebo) for initiation of labor at the start of week 39. Primary outcomes were the percentage of women entering the active phase of labor within 24 h after receiving castor oil or placebo and the number of successful VBAC deliveries.Results: Labor started in 16 patients (45.7%) within 24 h in the castor oil group and in 3 patients in the placebo group (8.5%), while the rate of successful VBAC was 65.7% (23 patients) in the castor oil group and 48.5% (17 patients) in the placebo group.Conclusion: Castor oil appears to be an effective, low-cost, and non-harmful method for the initiation of labor in patients with a previous cesarean section.
Collapse
Affiliation(s)
- Yomna Ali Bayoumi
- Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt
| | - Mahmoud Alalfy
- Reproductive health and family planning department, National Research Centre, Aljazeerah Hospital, Dokki, Egypt
| | - Mohamed Sharkawy
- Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt
| | - Ahmed S Ali
- Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt
| | | | - Dina Latif Hatem
- Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt
| |
Collapse
|
4
|
Beshir YM, Kure MA, Egata G, Roba KT. Outcome of induction and associated factors among induced labours in public Hospitals of Harari Regional State, Eastern Ethiopia: A two years' retrospective analysis. PLoS One 2021; 16:e0259723. [PMID: 34752507 PMCID: PMC8577748 DOI: 10.1371/journal.pone.0259723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 10/25/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Induction of labor (IOL) is an essential intervention to reduce adverse maternal and neonatal outcomes. It is also improved pregnancy outcomes, especially in resource-limited countries, where maternal and perinatal mortality is unacceptably high. However, there is a scarcity of evidence regarding the outcome of induction of labor and its predictors in low-income countries like Sub-Saharan Africa. Therefore, this study was aimed at assessing the outcome of induction of labor and associated factors among mothers who underwent labor induction in public Hospitals of Harari Regional State, Estern Ethiopia. METHODS A facility-based cross-sectional study was conducted from 1 to 30 March, 2019 in Harari Regional State, Eastern Ethiopia. A total of 717 mothers who underwent induction of labor in public Hospitals of Harari Regional State, Eastern Ethiopia from January 2017 to December 2018 were enrolled in the study. Data were collected using a pretested structured questionnaire. The collected data were entered into Epi-data version 3.1 and exported to SPSS version 24 (IBM SPSS Statistics, 2016) for further analysis. A multivariable logistic regression analysis was performed to estimate the effects of each predictor variable on the outcome of induction of labor after controlling for potential confounders. Statistical significance was declared at p-value <0.05. RESULTS Overall, the prevalence of success of induction of labor was 65% [95% CI (61.5, 68.5)]. Pre-eclampsia/eclampsia was found to be the most common indication for induction of labor (46.70%) followed by pre-labor rupture of fetal membrane (33.5%). In the final model of multivariable analysis, predictors such as: maternal age < 24 years old [AOR = 1.93, 95%CI(1.14, 3.26)], nulliparity[AOR = 0.34, 95%CI(0.19, 0.59)], unfavorable Bishop score [AOR = 0.06, 95%CI(0.03, 0.12)], intermediate Bishop score [AOR = 0.08, 95%CI(0.04, 0.14)], misoprostol only method [AOR = 2.29, 95%CI(1.01, 5.19)], nonreassuring fetal heart beat pattern [AOR = 0.14, 95%CI (0.07, 0.25)] and Birth weight 3500 grams and above[AOR = 0.32, 95% CI (0.17, 0.59)] were statistically associated with the successful outcome of induction of labor. CONCLUSION The prevalence of successful of induction of labor was relatively low in this study area because only two-thirds of the mothers who underwent induction of labor had a successful of induction. Therefore, this result calls for all stakeholders to give more emphasis on locally available induction protocols and guidelines. In addition, pre-induction conditions must be taken into consideration to avoid unwanted effect of failed induction of labour.
Collapse
Affiliation(s)
- Yimer Mohammed Beshir
- Department of Midwifery, Hiwot Fana Specialized University Hospital, Haramaya University, Harar, Ethiopia
| | - Mohammed Abdurke Kure
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Gudina Egata
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Kedir Teji Roba
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| |
Collapse
|
5
|
Fang X, Liu J, Duan L, Xue R, Zhang J, Liu W, Jiang Y. Application of painless nursing in cesarean delivery parturients due to the failure of natural childbirth via labor analgesia. Am J Transl Res 2021; 13:8134-8141. [PMID: 34377297 PMCID: PMC8340151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 03/28/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To evaluate the application of painless nursing in cesarean delivery parturients due to the failure of natural childbirth via labor analgesia. METHODS A total of 124 parturients who were transferred to cesarean delivery due to the failure of natural childbirth via labor analgesia were selected and randomly divided into two groups. The control group received routine nursing, while the research group was given painless nursing in the operating room, which mainly included interventions in terms of the environment, labor process, and delivery procedure. The visual analog scale (VAS), gestation outcome, stress response, anxiety, sleep quality, and nursing satisfaction were compared between the two groups. RESULTS Compared with the control group, the sleep quality score was significantly lower in the research group (all P<0.001). Compared with before nursing, the anxiety and VAS scores of the two groups were significantly decreased after nursing (P<0.001). Additionally, the anxiety and VAS scores of the research group after nursing were significantly lower than those of the control group (P<0.001). There was no significant difference for the gestation outcome between the two groups (P>0.05). Compared with before nursing, the levels of malondialdehyde (MDA) and reactive oxygen species (ROS) after nursing were significantly downregulated, while the level of superoxide dismutase (SOD) was significantly upregulated in both groups (all P<0.001). Compared with the control group, the levels of MDA and ROS were significantly lower, while SOD level was significantly higher in the research group after nursing (all P<0.001). Compared with the control group, the nursing satisfaction was significantly higher in the research group (P<0.05). CONCLUSION The painless nursing for cesarean delivery parturients in the operating room due to the failure of natural childbirth via labor analgesia can effectively improve the sleep quality and negative moods of the parturients, reduce the degree of pain and stress response in the process of delivery, and result in better satisfaction and compliance.
Collapse
Affiliation(s)
- Xuqin Fang
- Quality Control Office, Chun’an Hospital of Traditional Chinese MedicineHangzhou, Zhejiang Province, China
| | - Jinfeng Liu
- Department of Maternal and Child Health, The Second Hospital of DongyingDongying, Shandong Province, China
| | - Lili Duan
- The First Department of Obstetrics, The Eighth People’s Hospital of HengshuiHengshui, Hebei Province, China
| | - Rui Xue
- Department of Respiratory Medicine, Zaozhuang Hospital of Zaozhuang Mining GroupZaozhuang, Shandong Province, China
| | - Jinghua Zhang
- Operation Room, The Fourth Hospital of ShijiazhuangShijiazhuang, Hebei Province, China
| | - Wei Liu
- Fetal Heart Care Unit, The Fourth Hospital of ShijiazhuangShijiazhuang, Hebei Province, China
| | - Yuanying Jiang
- Operating Room, Chun’an Maternal and Child Health HospitalHangzhou, Zhejiang Province, China
| |
Collapse
|
6
|
Abstract
This review summarizes recent evidences regarding the potential influences of epidural labor analgesia (ELA) on the outcomes of neonates and children. Terms and relevant words including “ELA,” “ELA and neonatal outcomes,” “ELA and children's development,” and “ELA and children's neurocognitive development” were used to search articles published in PubMed database up to October 2019. Original articles and reviews regarding potential influences of ELA on neonates and children were identified. Relevant references of the selected articles were also screened. The anesthetics used during ELA can be absorbed, enter the fetus, and produce neonatal depression; however, these effects are less severe than those during systematic opioid analgesia. The impact of anesthetic exposure during ELA on children's neurodevelopment has not been fully studied, but would be mild if any. ELA increases the risk of intrapartum maternal fever; the latter may be harmful to neonatal outcomes. The use of ELA may increase birth injury by increasing instrumental delivery, although long-term adverse events are rare. On the other hand, ELA may reduce maternal depression and, thus, produce favorable effects on neurocognitive development in childhood; but evidences are still lacking in this aspect. ELA may produce both favorable and unfavorable effects on neonates and children. These effects should be discussed with parturient women before making decisions. The potential harmful effects should be carefully managed. The overall impacts of ELA on neonatal and children's outcomes need to be studied further.
Collapse
|
7
|
Tan SQ, Chen LH, Muhd Abdul Qadir D, Chern BSM, Yeo GSH. Risk factors and outcomes of uterine rupture in Singapore: Emerging trends. ANNALS ACADEMY OF MEDICINE SINGAPORE 2021. [DOI: 10.47102/annals-acadmedsg.2020319] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
ABSTRACT
Introduction: Uterine rupture is uncommon but has catastrophic implications on the pregnancy. A scarred
uterus and abnormal placentation are known contributory factors. The aim of our study was to review
the contributing factors, clinical presentation, complications and management of uterine rupture in our
population in light of the changing nature of modern obstetric practices.
Methods: A retrospective observational study was conducted at KK Women’s and Children’s Hospital
by studying proven cases of uterine rupture in the period between January 2003 and December 2014. These
cases were analysed according to their past history, clinical presentation, complications, management
and outcome.
Results: A total of 48 cases of proven uterine rupture were identified. The incidence of uterine rupture
was 1 in 3,062 deliveries. The ratio of scarred uterus rupture to unscarred uterus rupture was approximately
3:1. The most common factor was previous lower segment caesarean section for the scarred group, followed
by a history of laparoscopic myomectomy. Abdominal pain was the common clinical presentation in the
antenatal period, while abnormal cardiotocography findings were the most common presentation in
intrapartum rupture.
Conclusion: There is a notable shift in the trend of uterine rupture cases given the increasing use of
laparoscopic myomectomy and elective caesarean sections. While ruptures from these cases were few, their
presentation in the antenatal period calls for diligent monitoring with informed patient involvement in their
pregnancy care.
Keywords: Antenatal, laparoscopic myomectomy, birth after caesarean, rupture, VBAC
Collapse
Affiliation(s)
- Shu Qi Tan
- KK Women’s and Children’s Hospital, Singapore
| | | | | | | | | |
Collapse
|
8
|
Cheng Q, Bi X, Zhang W, Lu Y, Tian H. Dexmedetomidine versus sufentanil with high- or low-concentration ropivacaine for labor epidural analgesia: A randomized trial. J Obstet Gynaecol Res 2019; 45:2193-2201. [PMID: 31502323 DOI: 10.1111/jog.14104] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 08/14/2019] [Indexed: 12/22/2022]
Abstract
AIM To study analgesic effects of dexmedetomidine or sufentanil, both combined with ropivacaine, in epidural analgesia during labor. METHODS We recruited 160 primigravidae with full-term pregnancy who received epidural anesthesia during labor and randomized them into four groups to receive epidural administration of ropivacaine combined with sufentanil (RS1 and RS2 groups) or with dexmedetomidine (RD1 and RD2 groups). Systolic blood pressure, diastolic blood pressure and heart rate before anesthesia (T1 ), 15 min after anesthesia induction (T2 ), on delivery (T3 ) and 2 h postpartum (T4 ), together with visual analogue scale scores, Bromage scores, Ramsay scores, adverse reactions during analgesia and urinary retention at 6 and 24 h postpartum were recorded; the pH, PCO2 and PO2 of umbilical cord arterial blood and Apgar scores at 1, 5 and 10 min after childbirth were assessed. RESULTS RS1 group had significantly lower systolic blood pressure, diastolic blood pressure and heart rate than RD1 group at T2 and T3 (all P < 0.05), but not at T1. At T2 and T3 , the other three groups were lower than RS2 group in visual analogue scale and Ramsay scores (all P < 0.05). After childbirth, RD2 group had significantly higher PO2 result than other three groups (P < 0.05). At 6 h postpartum, RD2 group had significantly fewer cases of urinary retention than RD1 and RS1 groups (both P < 0.05). CONCLUSION A relatively low concentration of ropivacaine, combined with dexmedetomidine, is better in analgesia during labor.
Collapse
Affiliation(s)
- Qiuju Cheng
- Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong Province, China
| | - Xiaobao Bi
- Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong Province, China
| | - Weiqiang Zhang
- Department of Obstetrics and Gynecology, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong Province, China
| | - Yanling Lu
- Department of Obstetrics and Gynecology, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong Province, China
| | - Hang Tian
- Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong Province, China
| |
Collapse
|